Parathyroid
One of the most perplexing aspects of parathyroid disease is that the patient is often un-aware that the disease is present. Parathyroid disease symptoms include feeling tired or lethargic, difficulty in concentrating and what patients describe as just not “feeling like themselves.” Some patients experience feelings of malaise and generalized weakness. When people have parathyroid disease, most people do not even realize that they have this problem.
The disease is often diagnosed after a primary care physician performs routine laboratory tests that indicate there may be an abnormality of the parathyroid. One indicator is elevated calcium levels in the blood. In patients who are not hospitalized, elevated calcium levels generally indicate the need for further evaluation for hyperparathyroidism. The primary care physician generally refers the patient to an endocrinologist for further work-up and evaluation. If the biochemical tests performed confirm that the patient has parathyroid disease, the patient is referred to a surgeon for surgical removal of the parathyroid. Medical treatment is not ideal for parathyroid problems.
Symptoms
Symptoms generally include the following: fatigue, tiredness, and malaise. Joint pain, bone pain, lack of concentration, and even personality changes are also very typical symptoms. Patients also commonly report muscle weakness. Patients state that they are not quite as strong as they used to be, but they will often times blame it on their age. Some patients will describe having difficulties getting out of a chair as a result of their proximal muscle weakness.
Many patients have a history of kidney stones or blood in their urine, or recent history of bone fractures. Other symptoms include frequent urination and urination at night.
Hyperparathyroidism can run in families. There is definitely a familial association with primary hyperparathyroidism, and it can be associated with something called multiple endocrine neoplasias, which is a constellation of endocrine problems. If you have multiple family members that have had issues with primary hyperparathyroidism, then you certainly want to let your doctor know, so that this can be investigated and evaluated.
Diagnosis
Before coming to see the surgeon, your endocrinologist will usually reconfirm your labs in his/her office. Often times, he/she will ask you to collect your urine for 24 hours, and evaluate the calcium content. If you have not done this, you will want to do this prior to your evaluation with the BMI of Texas surgeon. Please bring the information recorded for the 24 hour collection to your initial surgical evaluation. Additionally, your endocrinologist should order a bone density scan prior to your surgical consult. This test must have been completed within the 12 month period prior to your surgical evaluation. The bone density scan is important because the parathyroid gland produces a hormone called parathyroid hormone. The hormone is then circulated and picked up by the bones, and it leeches the calcium out of the bones, thus making your bones weaker. The calcium that is leeched from your bones and circulated is collected and filtered out by the kidneys, and, therefore, patients develop kidney stones. Because of the bone weakening, you should definitely plan on having a bone density at least once a year after your parathyroid surgery.
The good thing about having surgery for primary hyperparathyroidism is that you can expect your bone density to increase. Yearly bone density scans, you will demonstrate the improvement of your bone density and validate your decision to pursue surgery. Likewise, kidney stones can be resolved and cured as a result of having your parathyroid surgery!
Surgery
Surgery lasts for anywhere between 1-3 hours. We do this surgery at the Methodist Specialty and Transplant hospital. The surgery is usually done on a Wednesdays. The incision is generally about 2"-3" in length and no more. The risks of surgery are low. There is a <1% chance of injury to an important nerve called the recurrent laryngeal nerve. This is the nerve responsible for your voice. There is also a less than 1% chance that all four parathyroid glands can be injured.
Recovery
After surgery, people spend one night in the hospital after a routine visit to the recovery room. Patients are walking, talking, eating and drinking the night of their surgery. Patients go home the following day, after being seen by the surgeon, and often times, the endocrinologist, as well. After surgery, there are no significant restrictions on you. We ask that you not drive a car for a couple of days because your neck is a likely to be somewhat sore. Most patients are discharged and do not require the use of narcotics for pain. After surgery, you will follow-up with your endocrinologist, as well as your surgeon. The appointment with your surgeon is usually within the first 2 to 3 weeks. During that time, most patients report feeling significantly better. Many patients report that, retrospectively, they feel like they were living in a ‘cloud’ or a ‘haze.’ Patients usually report feeling much sharper, much more attentive, and having much more energy.
After surgery, an overwhelming number of patients are cured, and most require no significant follow-up, other than one appointment with the surgeon. If everything is resolved, and your calcium remains normal after surgery, you will be followed by the endocrinologist and your primary care physician.
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♦ General Surgery